Table 3. Doctors’ Coping Behaviours That Moved Away From Patients/Beneficiaries.

	Illustrative Instances of Coping	Coping Strategies	Adaptive Processes	Implications on Care Provided
Outpatient care	One doctor reported having adequate drug supplies to do only one outpatient clinic in a day, rather than the mandated two (Action 1).	Rationing care	Resignation Sacrificing the professional Risk-averseness	Implications for outpatient care Doctors conducted only one outpatient clinic in a day (despite being mandated to conduct two). Doctors saw patients very quickly and made professional compromises while providing care. Doctors did not provide equal care to all patients. Doctors referred more patients than clinically required.
	One doctor reported that he saw the medicines that he had given a patient thrown on the footpath in front of the health facility. This incident made him feel that it was no use trying to help patients who did not trust his professional opinion. Now, the doctor resorts to judging patients instinctively and takes time/effort only if the patient appeared amenable (Action 2).	Routinising care Patient categorization
	Many doctors shared that the ‘actual’ work of the primary health center was to implement programs and schemes; and outpatient clinics were not important part of their reporting mandates. Hence, they rapidly dealt with outpatient work and focussed on other issues. It was felt that outpatient work was neither appreciated by patients or the organization (Action 3).	Prioritizing Routinizing care
	Doctors often reported giving preferential treatment to friends and relatives of local politicians. If they refused to do so, there was danger of these politicians creating obstacles to other outreach work (Action 4).	Patient categorization
	Some doctors reported that they had only a few drugs to work with in the health center, so they prescribed the same drugs again and again to patients (even while knowing that these drugs were not the best clinical choices). These doctors reported that patients would get angry if they sent them back without drugs or asked them to buy drugs from outside. At the same time, they did not have freedom within the institution to get better drugs. So, they resorted to giving drugs perfunctorily (Action 5).	Routinizing care Distancing
	One doctor referred all cases of delivery that came to his health center- since he felt that he neither had staff or facilities to deal with emergencies. He did not want to take a ‘risk’ (Action 6).	Invoking different policy understanding
Programs	Many doctors shared that too many schemes ran from the health centers; and staff numbers were adequate to do all outreach work. Hence, they overlooked short-cuts taken by staff during outreach (Action 7).	Rationing Routinizing Distancing	Policy alienation Gaming the system Resignation Risk-averseness.	Implications on programs Doctors ignored shortcuts taken by staff, contributing to compromises in outreach. Doctors reconciled themselves to the diluted, perfunctory delivery of schemes.
	One doctor tried to take action against a nurse who refused to complete duty-hours, but he received no support from the authorities to suspend her. He was told to “adjust” and carry on. After this incident, he stopped trying to better the implementation of schemes (Action 8).	Routinizing Distancing
	One doctor was told to open bank accounts for all patients with respect to a health scheme. He felt he should be given only “technical work” and not work of this sort, so he monitored only a few account openings (Action 9).	Invoking different policy understanding
	A doctor once forgot to call a local politician for an inauguration event of an immunization campaign, and this led to several implementation obstacles. Post this incident, he felt that politically appropriate launches were more important than the technicalities of the campaign itself- and hence changed the focus of his work (Action 10).	Invoking different policy understanding